Jyestha and Ashadh are two months of Grishma Ritu (summer). In the month of Jyestha, days are the longest in the year and the nights are the shortest. It is a known saying that more the heat in the month of Jyestha, more will be the rains in the month of Shravan (sawan).

The month of Jyestha is worshipped as month of worshipping water. It is a month for conserving water, maintaining water hygiene as well as donating water as charity to those who have scarcity of water. People who have servants at home or establishments with fourth class employees should see to it that their employees maintain personal, food and water hygiene. During scarcity of water, people may not wash their hands after going to toilets, take baths for days, wash their clothes for days or wash their utensils regularly. The end result is – a person may suffer from diarrhea, typhoid and jaundice. Heat disorders are also likely to occur in this season which may manifest as heat cramps, heat exertion or heat stroke.

Changing Practice – Evidence which has changed practice in last one year

Initial chemotherapy for metastatic pancreatic cancer

Start Folfirinox rather than gemcitabine for patients with metastatic pancreatic cancer who have a good ECOG performance status (0 or 1) and a serum total bilirubin level that is <1.5 times the upper limit of normal.

eMedinewS Audio PostCard

CKD Update

Dr KK Aggarwal Speaks on
‘Additional Lab tests: eGFR 30-60’

Photo Feature (from the HCFI Photo Gallery)

World No Tobacco Day

In a mock funeral, the Heart Care Foundation of India cremated the effigy of Mr. & Mrs. Tobacco suffering from effects of tobacco on 31st May 2004. This was done to create awareness about hazards of smoking, both active and passive.

National News

Medical Council of India sets aside Delhi Medical Council order

In a landmark judgment, Medical Council of India set aside Delhi Medical Council order in which they issued a stricture-cum-warning to Dr. Ashwini Dalmia, the then Secretary, Delhi Medical Association for professional misconduct. A complaint was made by Dr. H C Gupta to DMC that Dr. Dalmia in the DMA Bulletin has claimed himself to be an ‘elected member’ of DMC. The council in its order said that as the election post declaration of the results ended up in a dispute and was under consideration by Delhi Government, it was wrong on the part of Dr. Dalmia to claim himself to be a member of Delhi Medical Council and gave a verdict that this amounts to a ‘professional misconduct’.

An appeal was filed by Dr. Dalmia in MCI for review. Dr. Dalmia challenged the order of DMC on the plea that there was no stay by any court or by Delhi Government on the election results which were declared by Delhi Medical Association (for a member to be elected by the association to the Delhi Medical Council). As the elections were declared and there was no stay against the results, he argued that he was a valid member of the council.

In its order, MCI gave a verdict that no case of professional misconduct is made out against Dr. Dalmia. MCI set aside the order of Delhi Medical Council.

Emedinews opinion: DMC is an independent body and beyond politics. The in-fights of medical association should not be used as a mean to file cases against each other in the council.

The Delhi Medical Council observes that in light of the fact that the result of election of Delhi Medical Association member to Delhi Medical Council under section 3(3)(c) of Delhi Medical Council Act, 1997 having been disputed and being under consideration of the Govt. of NCT of Delhi under Section 3 (7) of Delhi Medical Council Act, 1997, which has not yet determined the same, it is wrong on the part of Dr. Ashwini Dalmiya to claim / project himself to be a Member, Delhi Medical Council. This action of Dr. Ashwini Dalmiya is highly objectionable and constitutes an act of professional misconduct.

The DMC therefore, issues a warning to Dr. Ashwini Dalmiya (DMC registration No. 7980) with a direction to refrain from such actions in future, till such time he has been legitimately declared to be elected to Delhi Medical Council.

MCI Order: 211(2) (855)/2010-Ethics/ appeal against order dated 28.09.2010 passed by DMC made by Dr. Ashwini Dalmiya “……the above mentioned matter was considered by the Ethics committee of the Council constituted by the Hon’ble Board of Governors, at its meeting held on 10th May, 2010 and it was decided as under:- “The Ethics Committee Considered the appeal of Dr. Ashwini Dalmiya against the order date 28.09.2010 of Delhi Medical Council Both the parties were heard and after perusing the records. Ethics Committee feels that no case of professional misconduct is made out against Dr. Ashwini Dalmiya. Therefore, the appeal is allowed ant the order of Delhi Medical Council is set aside”

Move over ‘sharbat’, ‘bel’ seeds are more precious

ALLAHABAD: Next time when you consume ‘bel’, (aegle marme–los), do not throw its seeds. This part of the fruit, earlier considered a waste, is beneficial for patients suffering from diabetes, high blood pressure and high cholesterol levels. Scientists at Allahabad University have found that the seeds of ‘bel’ have qualities to fight diseases. A research, published in the Journal of Ethnopharmacology and conducted by team of scientists led by Geeta Watal, associate professor, department of chemistry, Allahabad University, have reported that the extract from ‘bel’ seeds brings down the blood glucose level up to 60.84 per cent and that too just after 14 days of consumption. (Source: TOI, May 17, 2011)

Many studies have also shown that mothers’ exercise and eating patterns can affect their children’s weight, their predisposition to exercise, and their overall health as adults. Now, a new study, Early Human Development, adds a category to that list by showing evidence that exercising during pregnancy can improve fetus’ cardiovascular health. Researchers at the Kansas City University of Medicine and Biosciences collected fetal heart measurements from 66 fetuses when their mothers reached 28, 32 and 36 weeks of pregnancy. The researchers divided mothers into two groups: one group engaged in moderate to vigorous aerobic activity for 30 minutes at least three times a week while the members of the other group didn’t exercise at all. At 32 weeks, researchers started to see changes in heart response in the fetuses of the exercising moms and at 36 weeks, they noted significant changes, including a lower heart rate and increased heart rate variability.

(Dr Monica and Brahm Vasudev)

FDA panel recommends new rules for kids’ paracetamol

FDA has recommended that children’s medications containing paracetamol provide weight–based dosing instructions, specific instructions for infants, and just one dose for pills, chewables, and meltaway tablets.

3,500–year mummy is oldest heart disease case

LONDON: An Egyptian princess who lived 3,500 years ago is thought to be the first known person to have had heart disease, say experts. An international team, which analysed the remains of 52 mummies, including that of the princess, claims that she would have needed a heart bypass surgery if she were living now, for scans show she had coronary artery disease. Princess Ahmose–Meryet–Amon was from an illustrious Egyptian family. She lived in what is now Luxor from the year 1580 BC, and died in her 40s. Her mummified body has been kept at the National Museum of Antiquities, Cairo. According to the researchers, the princess, who lived on a diet rich in vegetables, fruit, limited meat and plenty of fish from Nile river, had extensive blockages in arteries leading to her heart, brain, stomach and legs. The researchers say her case shows heart disease pre–dates a modern lifestyle. Gregory Thomas of the University of California, who led the team, said, "There was no gas or electricity at that time, so presumably she had an active lifestyle. Her diet was significantly healthier than ours. She would have eaten fruit and vegetables and fish were plentiful in the Nile at that time. The food would have been organic — and there were no trans–fats or tobacco available then. "Yet, she had these blockages. This suggests to us that there’s a missing risk factor for heart disease — something that causes it that we don’t yet know enough about." (Source: TOI, May 19, 2011)

ATS: Daily use of antibiotic keeps COPD at bay

Chronic obstructive pulmonary disease (COPD) patients at high risk of an acute exacerbation can postpone the event by taking a daily antibiotic, a researcher said here. In a randomized, placebo–controlled trial, the time to a COPD exacerbation was significantly delayed for patients taking azithromycin (Zithromax), according to Richard Albert, MD, of Denver Health Medical Center. The frequency of exacerbation was also lower among azithromycin patients compared with those who got only standard COPD care, Albert told a late–breaking abstract session at the American Thoracic Society meeting. (Source: Medpage Today)

Twitter of the Day

@DrKKAggarwal: 56 died in UP & Bihar when severe duststorm accompanied by rain & thundershowers lashed, according to All India Radio.

@DeepakChopra:God gave humans the truth and the devil said "Lets organize it and call it religion"

Spiritual Update

Hanuman Chalisa

Prabhu Mudrika Meli Mukha Maaheen
Jaladhi Langhi Gaye Acharaj Naheen

Meaning: You crossed the ocean keeping Rama’s ring in your mouth as a token for Sita.

Spiritual Significance: Crossing the ocean with Rama’s Ring (Beej Mantra) indicates the process of Chakra Meditative Pranayama. One needs a vehicle of mantra, image or sound to cross over the ocean of thoughts.

An Inspirational Story

(Dr Prachi Garg)

The precious stone

A wise woman who was traveling in the mountains found a very unique and precious stone in a small river. The next day she met another traveller who was hungry, and the wise woman opened her pack to share her food. The hungry traveler saw the special stone in the wise woman’s bag, appreciated it, and asked the wise woman to give it to him. The wise woman did so without hesitation. The traveler left, rejoicing in his good luck. He knew the stone was worth enough to live peacefully for the rest of his life. But a few days later he came back, searching for the wise woman.

When he found her, he returned the stone and said, I have been thinking. I know how valuable this stone is, but I give it back to you in the hope that you can give me something much more precious. If you can, give me what you have within you that enabled you to give me the stone.

Bronchiolitis is a clinical syndrome characterized by the acute onset of respiratory symptoms in a child younger than 2 years of age. Typically, the initial symptoms of upper respiratory tract viral infection, such as fever and coryza, progress within 4 to 6 days to include evidence of lower respiratory tract involvement with the onset of cough and wheezing. It is a clinical diagnosis based on typical history and examination findings, with no specific confirmatory or exclusionary diagnostic test or gold standard.

IJCP Special

Dr Good Dr Bad

Situation: A patient was found to have relative bradycardia. Dr. Bad: It is classical typhoid. Dr. Good: It may be typhoid. Lesson: Temperature pulse dissociation or relative bradicardia is seen in typhoid fever, brucellosis, leptospirosis, drug–induced fevers and factitious fever. In healthy subjects, the temperature pulse relationship is linear with an increase in heart rate by 2.44 beats per minute for each 1°F rise in core temperature.

Make Sure

Situation: A patient with asymptomatic sinus bradycardia after PPI developed lead infection. Reaction: Oh my God! Why was PPI (Permanent pacemaker implantation) done? Lesson: Make sure that PPI is not implanted in patients with sinus bradycardia without significant symptoms, Sinoatrial block or sinus arrest without significant symptoms, Asymptomatic prolonged RR intervals with atrial fibrillation or other causes of transient ventricular pause and asymptomatic bradycardia during sleep.

Obesity Update

Dr. Parveen Bhatia and Dr. Pulkit Nandwani

Which exercises are best for weight loss?

Perform exercises that target the major muscles groups, such as your chest, back and shoulders. In addition to weight machines and dumbbells, rubber tubing or elastic bands to provide the resistance can be used.

Aquatic exercises/swimming offer resistance for muscles while placing little impact on the joints. Perform these exercises twice a week and gradually increase to three times per week.

Begin with one set of 12 to 15 repetitions per exercise and gradually progress to two sets per exercise using enough resistance so that it’s a slight struggle to complete the last couple of repetitions.

Slowly warm up body before resistance training. For example, walk or do light calisthenics for at least 10 minutes.

SMS of the Day

(Dr GM Singh)

A wise schoolteacher sends this note to all parents on the first day of school: "If you promise not to believe everything your child says happens at school, I’ll promise not to believe everything he says happens at home.

Rabies Update

(Dr AK Gupta, Author of "RABIES – the worst death")

Should the dog bite wound be allowed to bleed, bandaged, or stitched?

Do not bandage the wound as far as possible and if unavoidable, apply non–adherent, absorbent dressings (paraffin gauze and Melolin) to absorb the discharge from the wound. Do not use tincture iodine. Avoid suturing of the bite wound as a rule since it may risk inoculation of the virus deeply into the wound. However, if the wound has to be sutured, it should be done as late as possible from several hours to 3 days and after infiltration of RIGs. If RIGs is not available, as a last resort, the wound must be flushed with povidone iodine before suturing. The suture should be loose and not interfere with free bleeding and drainage. Human and animal bite wounds are best closed by secondary sutures after one week and after proper cleansing and daily wound care. Primary surgical intervention must be avoided if possible.

Can the wound be deepened for cleaning purpose?

We should never try to deepen the bite wound by cutting it further to bleed and then clean the wound.

Cervical cancer, the second most commonly diagnosed cancer among women worldwide, can be a preventable disease. Although the Pap smear remains the most common screening test for cervical cancer, many less developed countries do not have adequate resources to implement cytology–based prevention programs. An alternative, low–cost test, visual inspection using acetic acid (VIA), has emerged for use in low–resource settings where it can be performed by auxiliary health professionals. VIA is similar to colposcopy in that acetic acid is applied and any acetowhite lesion is visualized, although with VIA there is no magnification. 3–5% acetic acid is applied to the cervix with cotton swab or sprayed with syringe and wait for 1 minute and then observe with naked eye for any white lesion. If any positive finding then either we can do targeted biopsy or colposcopy depending on the facilities available or if done by ANM can be referred for follow up to a higher centre.

For preservation of viscera, clean, wide-mouthed glass bottles fitted with glass stoppers of one liter capacity should be used. Rubber inserts under caps should preferably not be used.

20–30 ml of blood taken from femoral artery or vein by skin puncture should be collected in 60ml screw–capped bottles or in plastic capped tubes/10 mg of sodium or potassium fluoride per ml of blood should be added in blood for preserving blood.

20–30 ml of urine is obtained from direct puncture of the bladder during the postmortem examination with a syringe and needle and should be collected in 60 ml screw–capped bottles or in plastic capped tubes and 20–30mg of thymol blue or boric acid or acetic acid should be added as preservative

A kindergarten teacher was observing her classroom of children while they drew. She would occasionally walk around to see each child’s artwork. As she got to one little girl who was working diligently, she asked what the drawing was. The girl replied, "I’m drawing God."

The teacher paused and said, "But no one knows what God looks like." Without missing a beat, or looking up from her drawing, the little girl replied, "They will in a minute."

In a large population–based sample, sildenafil use was associated with hearing loss; no association was found for tadalafil or vardenafil.

Public Forum

(Press Release for use by the newspapers)

Even low cholesterol may be harmful

One can keep healthy by following the laws of nature, said Padma Shri & Dr. B.C. Roy National Awardee Dr. KK Aggarwal and President, Heart Care Foundation of India.

Any use, misuse or over use of anything is bad. If the uterus is not used for producing a baby it will produce a fibroid tumor, or if it is overused in producing babies it can end up with cancer. The same is true with drugs. If cholesterol is high, it can cause heart attack and if the cholesterol is very low, it can cause cancer.

Quoting a study published in Journal of American College of Cardiology, Dr. Aggarwal said that if cholesterol is lowered more than normal using anti cholesterol drugs there is a small chance of developing cancer. That is one reason why cholesterol drugs have to be given under medical supervision. Internationally there has been a move to make anti cholesterol drugs as over–the–counter (OTC) drugs, which is not the right move for India.

In the study, a slight increase in cancer incidence was found in 13 trials evaluated. The increase in cancer incidence was found in statin users who achieved the lowest LDL or the bad cholesterol levels and did not involve any specific type or location of cancer.

Readers Response

Translation of Hanuman Chalisha is a brilliant idea. It is good to know the meanings of all our mantras and prayers, you can feel them better chant them better from your heart, great job. Dr Aggarwal, Dr Vivek Kumar, Varanasi.

from Sept 29, 2011: A unique & highly educative Pre–Conference CME, International & national icons in the field of cardiology & echocardiography will form the teaching faculty.
• Provisional Scientific Program at http://worldcon2011.org/day1.html
• Provisional program for Pre Congress CME at http://worldcon2011.org/Pre_Conference_CME.html
• Abstract submission at http://worldcon2011.org/scientificprogram.html
• Important dates at http://worldcon2011.org/importantDates.html
• Congress website at http://www.worldcon2011.org
• Entertainment – Kingdom of Dreams at http://worldcon2011.org/Pre_Post_Tours.html